This is a blog by a former CEO of a large Boston hospital to share thoughts about hospitals, medicine, and health care issues.

Tuesday, December 22, 2009

Forming bonds between Atrius Health and BIDMC

Last week, I sent this staff email following up on our earlier announcement about the new clinical partnership between Atrius Health and BIDMC. It gives you a sense of how we are preparing for this joint venture, but also provides the broader context. Gene Lindsey's comment holds even more power in light of the direction of recent legislative activity in Washington, DC.

Dear BIDMC,

As you may have read a few weeks ago, Atrius Health and BIDMC have entered into a new patient care partnership. Starting January 4, patients from the Harvard Vanguard Kenmore, Copley, and Post Office Square Centers will be coming here for emergency care and tertiary care. We have had teams from both organizations working for months on the logistics and planning for this, and we are in good shape to proceed. (For example, read John Halamka's blog for details of some of the items involved in the IT arena.)

We had a welcoming reception last night in the Shapiro lobby, and it was a great chance for clinicians, administrators, and board members from both institutions to get together and to celebrate the work that has gotten us this far. It was striking how many of these folks already had relationships, some dating back to their training days.

Over the coming days and weeks, you will see some new people from Atrius on our floors as this rolls out, especially hospitalists and case managers, but also people in specialty areas. I know you will make them feel welcome.And I am absolutely confident that patients from Atrius will see the same level of care we strive for all the time, the kind of care we would want a member of our own family to receive. But, we want this to be more:

Gene Lindsey, the Atrius CEO, and I have met with each other's senior management team, and we have a simple and a hard message for both organizations. We aim for this partnership to set a new standard for patient care in the region. As a tertiary center, we plan to be exceptionally responsive to the primary care-centered model of care exemplified by Atrius(and also enhancing how we do so with our own superb primary care practices at Healthcare Associates, APG, and the community health centers). Together, we look forward to setting higher bars in safety and quality, aided by transparency. We will also work together using the philosophy, measures, and techniques of the Lean process to improve the work environment for all.

(In that regard, I am officially declaring the end of BIDMC SPIRIT, which was an inward-looking approach to process improvement. SPIRIT was based on Lean principles, and we learned a lot from it. But we now start to enter a different phase of process improvement, one based on JOINT action with our clinical partners, starting first with Atrius. In the last few months, Alice Lee and her team have been teaching us more about Lean. Many of you have participated in rapid improvement events and other training. That will continue, but, in Atrius, we have a partner who has been engaged in similar training, and we aim to learn from one another and apply this philosophy to our joint operations.)

More broadly, Gene recently addressed aspects of our mutual goal in a newsletter to his staff. He noted:

“How do we reform healthcare?” That is a big tough question. This week I heard Don Berwick from the Institute for Healthcare Improvement point out that the question in Washington has shifted toward, “How do we reform health insurance?” By changing the question, the President is indicating his understanding of the limits of legislation. He understands that politicians can change the way people access care, or how care is financed, but they cannot change how care is delivered and legislators will always find it difficult to create quality.

Politicians can increase the funding of health care, but a reform of the practice of healthcare is our domain. Only we, the community of practice, can improve quality and change the systems of care in such a way as to improve the experience of care for individuals, improve the health of the nation and end the extortion of much needed funds from the other categories of our collective societal experience. Only we, the good people who provide the care, can create the solutions that end the fragmented, mediocre and unsafe experience of care that is the experience of so many of our citizens.

We control the experience of health care for our patients far more than we might want to admit. Since so often they do exactly what we tell them to do when we suggest a test, or a surgery, we need to be very sure that we try to see the world as they do as we give them our counsel. Being patient-centered is the hardest task we have because for many of us it means trying very hard to convince patients that they should do what we think is best.

What gets done is usually what we order. The options that most patients have are the ones that we offer. Their experience of care is the experience we provide. If we care about our patients, the first question that must be answered is “What do they really really want?”

Note that the focus here is what patients really want. They do not want MRIs, CT scans, or procedures. They want to live happy and healthy lives. They want us to listen to them and understand their needs. This was put so clearly by Dr. Amy Ship, when she recently accepted the Compassionate Caregiver Award from the Schwartz Center. Please take 8 minutes to watch and listen to Amy's speech, here.

Gene and I are excited about the Atrius-BIDMC partnership because we think it provides a vehicle for learning how to do this and for spreading the word to our community. We invite you to join this adventure and be active participants.

That's a lot to chew on, all in one post. From a "SPIRIT" perspective, this "end" is just a new beginning, right?

The idea of collaboration across enterprises is interesting, from a lean and process improvement standpoint. Meeting true customer needs (back to Don Berwick's question of what we REALLY want) will require this sort of collaboration and cooperation across everybody who touches us, the patients.

From a lean and process improvement standpoint. Meeting true customer needs (back to Don Berwick's question of what we REALLY want) will require this sort of collaboration and cooperation across everybody who touches us, the patients.

Paul - Halamka's 12/14/09 blog talks about the eCW EHR and how "it is capable of receiving other lab feeds such as Milton or Caritas..." funny the way he singled out Caritas. Is that another relationship like Atrius?

I hope you understand that the point is that they may want those procedures, but it is all in the service of getting healthy again. There is no inherent demand for a particular procedure. It is derivative of wanting to get well.

Paul; Is this the sort of arrangement you are referring to with Atrius?http://www.patientsafetymonitor.com/breakthroughs/getPDF.cfm?PDF=243248.pdf(warning; pdf. Hope this link works)

76 degrees is right, there is a difference between what patients THINK they want and what they really want=need. That is a continuing problem for cost containment these days given the malpractice issues.

Paul - OK, there is no inherent demand and pstients want to get well (but there can be other confounding factors). Hearing/reading about procedures creates interest if there is a referable symptom particularly. Interest may lead to desire; desire may lead to demand. And this is not always wrong...patients can be right. Hopefully in primary care, we make use of longitudinal relationships to "get it right" for the patient.

Speaking of SPIRIT and ideas, here's one I saw in today's WSJ interview with CEO of SunGard: an internal "craig's list" type website for posting excess equipment. (Anyone who majored in astrophysics and minored in Sanskrit has got to be interesting.)Wonder if this would work in a hospital.....